Provider Demographics
NPI:1548559586
Name:WAVELAND DENTAL CENTER PLLC
Entity Type:Organization
Organization Name:WAVELAND DENTAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:HAL
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:228-270-0044
Mailing Address - Street 1:110 AUDERER BLVD
Mailing Address - Street 2:
Mailing Address - City:WAVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39576-2432
Mailing Address - Country:US
Mailing Address - Phone:228-270-0044
Mailing Address - Fax:228-270-0047
Practice Address - Street 1:110 AUDERER BLVD
Practice Address - Street 2:
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576-2432
Practice Address - Country:US
Practice Address - Phone:228-270-0044
Practice Address - Fax:228-270-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty